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* 1. Name

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* 2. Organization

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* 3. Are you a paid member of EPIP?

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* 4. Do you want to sign up for an EPIPhany Group?
(EPIPhany Groups are a pilot initiative of EPIP Boston to give members the opportunity to connect with one another via email and/or in-person across common professional interest areas.)

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* 5. If you want to sign up for an EPIPhany Group, what are your areas of interest?

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* 6. Are you interested in becoming an EPIP Ambassador?
(Ambassadors work with Steering Committee Officers who oversee the programming, membership and/or communications roles to help EPIP fulfill its mission)

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* 7. If you are interested in becoming an EPIP Ambassador, what areas are you most interested in?

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